Imagine this scenario: There are two people with Alzheimer’s disease. They are the same age and have had similar Alzheimer’s-related changes in their brains. The first person shows few signs of the condition. The second person, meanwhile, is regularly mixing up dates, forgetting words and having a hard time completing tasks that once felt easy—all clear signs of cognitive decline.
How could two people in such similar situations have such different results?
The difference can be explained by cognitive reserve, says Jonathan Graff-Radford, M.D., a neurologist and Alzheimer’s specialist at Mayo Clinic in Jacksonville, Florida. Cognitive reserve is the brain’s ability to maintain thinking and memory despite age- or disease-related changes in the brain.
What is cognitive reserve?
“I describe cognitive reserve as the ability to perform better than expected, despite the presence of brain changes or damage,” says Dr. Graff-Radford.
The brain is composed of billions of neurons—nerve cells that collect, process and send information. A complex network of electrical circuits allows the neurons to “talk” with one another. The brain’s neural connections are crucial and allow you to think, feel, remember, retain and process information, and perform a wide range of other tasks and functions.
Dementia is a group of symptoms that affect memory, thinking, mood and behavior. Alzheimer’s disease is the most common cause of dementia and is related to the accumulation of two specific proteins—amyloid and tau—in the brain. These proteins damage neurons and the fibers that connect them, leading to progressive cognitive decline.
Even for those who do not develop dementia, the number of neurons in the brain slowly declines due to aging. And after age 60, the brain begins to shrink more quickly. These changes can affect cognitive functions like memory, processing speed, decision-making and learning—all areas that may leave you feeling a little less sharp as you get older. These brain changes are expected and are a typical part of getting older.
Cognitive reserve can compensate for some changes due to aging or Alzheimer’s disease by using existing neural networks more efficiently or recruiting alternative networks to perform tasks. In other words, cognitive reserve can keep your brain adaptable and help preserve your mental sharpness.
In addition, some people may demonstrate cognitive resistance, which is a related term often confused with cognitive reserve. Cognitive resistance refers to the brain’s ability to avoid or delay developing age-related or disease-related brain changes. Cognitive reserve, on the other hand, refers to the brain’s ability to maintain function despite changes in the brain.
Does cognitive reserve prevent dementia?
Cognitive reserve does not prevent the brain changes associated with dementia, but it may help delay the onset of cognitive symptoms or allow a person to maintain cognitivefunction longer despite those changes.
It is important to understand that cognitive reserve isn’t always enough to prevent eventual cognitive decline. “There is a point where people can accumulate so much damage that they start manifesting their disease despite having a high degree of cognitive reserve,” says Dr. Graff-Radford.
How can you build cognitive reserve?
Activities and experiences that challenge the brain throughout life may help build cognitive reserve. Research has associated higher cognitive reserve with education, lifelong learning, mentally stimulating activities and other forms of intellectual engagement.
“Research suggests that cognitive reserve develops across the lifespan, and it’s influenced by experiences, environmental and genetic factors,” says Dr. Graff-Radford. “Education is an early life experience that’s associated with cognitive reserve later on in life. “
Is it ever too late to build cognitive reserve?
Although cognitive reserve develops over many years, there is evidence that even in middle-age and beyond, it is still possible to improve your cognitive performance and build up your reserve. In fact, a cohort study of more than 10,000 adults age 70 or older found that regularly participating in activities such as taking classes, writing, playing cards and doing crossword puzzles was linked to a lower risk of dementia over 10 years.
Additionally, there are a number of lifestyle changes—both big and small—that can help protect your brain health. These include good sleep hygiene, regular physical activity and staying proactive about managing any health conditions, including diabetes, cardiovascular conditions, anxiety and depression. Staying socially active is also an important part of the equation. Social isolation and loneliness, in particular, have been linked to cognitive decline. Staying connected might look like regular phone calls with family, joining a workout class or inviting a neighbor over for dinner.
Finally, Dr. Graff-Radford encourages annual vision and hearing exams. Although you may not associate your eyes and ears with brain health, untreated hearing loss and vision loss are associated with an increased risk of dementia. In fact, research suggests that treating hearing loss with hearing aids may be linked to a lower risk of cognitive decline and dementia.
How can you build cognitive reserve into a daily routine?
You may have seen advertisements for “brain training” or “memory optimization.” But there isn’t any single tool or task that will enhance your cognitive reserve. Instead, it’s about sustained habits over a period of time.
Ideally, these brain-boosting habits are things you find joy in. “You don’t have to do every activity on the list,” says Dr. Graff-Radford. “Try to emphasize the activities you find enjoyable, and incorporate them into your daily routine.”
If you read for pleasure, stop by the library once a week to check out a new book. If you love games, get some friends together to play cards or hit the pickleball court. Others may enjoy taking an art class, playing music or learning a new language. The more you enjoy something, the more likely you are to keep doing it. Remember, cognitive reserve isn’t just about intellectual pursuits. Meaningful social relationships and physical activity can help keep your mind sharp and protect your brain health.
In short, activities that challenge the brain, foster social connection and promote physical health all may contribute to cognitive reserve.
If you are concerned about your memory, talk to a healthcare professional. There are tests available to assess your condition and determine if there may be an underlying causes.
